Beyond the Autism Spectrum: Toward More Precise Neurodevelopmental Classification

The Problem With “Autism” as a Master Label

(Originally written in English)

The word "autism" has outlived its scientific usefulness. What began as a clinical description has turned into an overstretched catch-all term. Today, it groups too many biologically, cognitively, and functionally different people under a single, vague behavioral word. It is an administratively convenient shortcut, but it is a scientifically imprecise category that hides far more than it explains.

The Illusion of the Master Label

The Greek root of the word autism means "self". This etymology highlights a stark contradiction, as a word historically meant to describe being "locked in the self" completely fails to capture the rich sensory, biological, and cognitive profiles of what the label actually includes in the first place.

Consider the sheer breadth of the current definition. Under the exact same diagnostic master label, we place an individual who is nonspeaking, lives with epilepsy, and has an intellectual disability alongside an individual who is highly verbal, holds a high IQ, and struggles primarily with executive function and sensory exhaustion.

Calling both of these people simply "autistic" is a lazy institutional shortcut. Adding the word "spectrum" does not solve this issue either. It merely admits that the category is massive, serving as a blanket approach that fails to provide any real clinical precision.

The primary scientific criticism of an autism diagnosis is that it remains entirely phenotype-based rather than biomarker-confirmed. The current diagnostic process relies on a combination of developmental history, caregiver or patient reports, and professional observations of behavior. The Centers for Disease Control and Prevention (CDC) describes the DSM-5 diagnosis as one based on persistent social communication differences and restricted or repetitive behaviors. Because there is no singular brain scan, blood test, or genetic marker to confirm the diagnosis, the label describes how a person presents clinically, not what is happening physiologically or neurologically underneath.

Institutional Simplification and Control

This creates a massive gap between institutional labeling and human reality. We use "autism spectrum disorder" for medical billing, school accommodations, and service eligibility. It is a system built for bureaucratic convenience. However, we should never confuse administrative usefulness with biological or clinical accuracy.

This top-down categorization reflects a deeper issue of social power. Historically, when dominant groups hold the exclusive power to name and classify a diverse minority, that name easily becomes a tool for simplification and control. In this case, the institutions doing the classifying include clinicians, researchers, insurance companies, and non-autistic society.

The people being classified have rarely had equal power in defining what the category actually means. When we apply one broad name to a highly diverse population, we erase individual differences. This reinforces public stigma because the public hears just one word and imagines a single stereotype.

Reframing via Double Empathy and RDoC

Dr. Damian Milton exposed this flawed dynamic through his framework called the Double Empathy Problem. Traditionally, the medical community blamed autistic individuals for social failures, claiming they suffered from an inherent deficit in empathy.

Dr. Milton reframed this entirely. He did not claim that non-autistic people are literally equally poor at empathy in every single context. Instead, his argument is that the communicative and empathetic mismatch between autistic and non-autistic people is strictly reciprocal. The social breakdown is a relational byproduct of two different neurotypes interacting, meaning the deficit cannot be located solely inside the autistic person. By showing that social difficulties are bidirectional, his work challenges the entire idea of autism as a monolithic behavioral disorder.

If the master label is broken, how do we fix it?

Some progress is happening. The ICD-11 now classifies autism with specific indicators for intellectual development and functional language. This is a step up from a completely undifferentiated label, but it still does not address the root causes.

A much better logical approach is found in the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) project. The NIMH explicitly states that RDoC is a research framework and is not intended to supersede or replace current diagnostic manuals. However, its value lies in its mechanism-oriented research logic. It deliberately moves scientific focus away from traditional symptom boxes and toward measurable dimensions like specific cognitive processes, neural circuits, physiology, and genetics.

We need to move toward clinical systems that eventually mirror this logic, classifying people by the measurable, mechanism-based source of their differences. We should look at specific genes, neural networks, or developmental pathways. Moving away from a lazy behavioral shortcut and toward biological precision will lead to much better, tailored support. Most importantly, it is a shift that could reduce the institutional stigma that a single, overused label creates.